Toxic leukoencephalopathy - methotrexate

Discussion:

This patient received both intrathecal methotrexate and whole body (including cranial) irradiation. They then presented with gradual decrease in cognitive function.

Findings are thought to be consistent with a toxic leukoencephalopathy.

Intravenous methotrexate is associated with TL in 10% whereas it is seen in up to 40% of those who are treated by the intrathecal route.

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